Presence Of Gallstones Research Articles

Incident Gallstones During Somatostatin Analog Treatment are Associated with Acute Biliary Complications Especially After Discontinuation.

IntroductionGallstones are a known adverse effect of somatostatin analogs, but the exact incidence and clinical implications are unknown.ObjectivesThe aim of this study was to investigate the incidence of gallstones on imaging and related complications in unbiased trial data.MethodsData from the DIPAK 1 trial, in which 305 polycystic kidney disease patients were randomized to standard of care (SoC) or lanreotide for 120 weeks, were used. Magnetic resonance imaging (MRI) was performed at baseline and end of treatment and was assessed for the presence, number, and size of gallstones. For all patients who had gallstones at the end of the trial, we obtained follow-up after the trial.ResultsOf 249 patients with data available, 11 patients randomized to lanreotide and four randomized to SoC had gallstones at baseline. During the study, new gallstones were formed in 19/124 patients using lanreotide (15%) and 1/125 patients receiving SoC (1%). The odds ratio for gallstone formation with lanreotide use was 25.9 (95% confidence interval 3.37–198.8; p < 0.001). Gallstones during lanreotide treatment were multiple (> 20 stones in 69% of patients) and small (≤ 3 mm in 63% of patients). Of the 19 patients with incident gallstones during lanreotide treatment, 9 experienced gallstone-associated complications, 8 of whom experienced gallstone-associated complications after discontinuation of treatment (median time after discontinuation 2.5 years). In patients with gallstones at baseline and in patients receiving SoC, no complications occurred.ConclusionsTreatment with a somatostatin analog leads to the formation of multiple, small gallstones that are associated with severe complications, especially after discontinuation of therapy.Clinical Trial Registry Website and Trial NumberClinicalTrials.gov (https://clinicaltrials.gov); NCT01616927.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40268-021-00342-7.

Contrast-enhanced ultrasound to assess gallbladder polyps

PurposeTo assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. MethodsA total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. ResultsThere were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. ConclusionVascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.

Association between gallstones and the risk of biliary tract cancer: a systematic review and meta-analysis.

OBJECTIVESBiliary tract cancers (BTCs) are rare but highly fatal. Although the etiology of BTC is poorly understood, gallstones are proposed to be a major risk factor. We conducted a systematic review and meta-analysis to examine the associations between gallstone characteristics and BTC risk.METHODSWe searched the MEDLINE, Embase, and Cochrane Central databases and systematically reviewed cohort and case-control studies published before April 9, 2018. All the included studies reported appropriate risk estimates and confidence intervals (CIs) for associations between the presence, size, number, or duration of gallstones and the risk of BTC, including gallbladder cancer (GBC), extrahepatic bile duct cancer (EBDC), and ampulla of Vater cancer (AOVC). Summary odds ratios (ORs) and their 95% CIs were calculated using a random-effects model in the meta-analysis. Subgroup analyses were conducted to inspect sources of potential heterogeneity, and the Egger test was performed to assess publication bias.RESULTSSeven cohort studies and 23 case-control studies in Asian, European, and American populations were included. The presence of gallstones was associated with an increased risk of BTC (OR, 4.38; 95% CI, 3.23 to 5.93; I2=91.2%), GBC (OR, 7.26; 95% CI, 4.33 to 12.18), EBDC (OR, 3.17; 95% CI, 2.24 to 4.50), and AOVC (OR, 3.28; 95% CI, 1.33 to 8.11). Gallstone size (>1 vs. <1 cm; OR, 1.88; 95% CI, 1.10 to 3.22) was significantly associated with the risk of GBC.CONCLUSIONSGallstone characteristics, such as presence, size, and number, are associated with an increased risk of BTC. However, significantly high heterogeneity in the meta-analyses is a limitation of this study.

The Role of Gallstones in Gallbladder Cancer in India: A Mendelian Randomization Study.

Past history of gallstones is associated with increased risk of gallbladder cancer in observational studies. We conducted complementary observational and Mendelian randomization (MR) analyses to determine whether history of gallstones is causally related to development of gallbladder cancer in an Indian population. To investigate associations between history of gallstones and gallbladder cancer, we used questionnaire and imaging data from a gallbladder cancer case-control study conducted at Tata Memorial Hospital, Mumbai, Maharashtra, India (cases = 1,170; controls = 2,525). We then used 26 genetic variants identified in a genome-wide association study of 27,174 gallstone cases and 736,838 controls of European ancestry in an MR approach to assess causality. The association of these genetic variants with both gallstones and gallbladder cancer was examined in the gallbladder cancer case-control study. Various complementary MR approaches were used to evaluate the robustness of our results in the presence of pleiotropy and heterogeneity, and to consider the suitability of the selected SNPs as genetic instruments for gallstones in an Indian population. We found a strong observational association between gallstones and gallbladder cancer using self-reported history of gallstones [OR = 4.5; 95% confidence interval (CI) = 3.5-5.8] and with objective measures of gallstone presence using imaging techniques (OR = 2.0; 95% CI = 1.5-2.7). We found consistent causal estimates across all MR techniques, with ORs for gallbladder cancer in the range of 1.3-1.6. Our findings indicate a causal relationship between history of gallstones and increased risk of gallbladder cancer, albeit of a smaller magnitude than those found in observational analysis. Our findings emphasize the importance of gallstone treatment for preventing gallbladder cancer in high-risk individuals.

Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients.

Acute cholecystitis can be difficult to diagnose in the emergency department (ED); no single finding can rule in or rule out the disease. A prediction score for the diagnosis of acute cholecystitis for use at the bedside would be of great value to expedite the management of patients presenting with possible acute cholecystitis. The 2013 Tokyo Guidelines is a validated method for the diagnosis of acute cholecystitis but its prognostic capability is limited. The purpose of this study was to prospectively validate the Bedside Sonographic Acute Cholecystitis (SAC) Score utilizing a combination of only historical symptoms, physical exam signs, and point-of-care ultrasound (POCUS) findings for the prediction of the diagnosis of acute cholecystitis in ED patients. This was a prospective observational validation study of the Bedside SAC Score. The study was conducted at two tertiary referral academic centers in Boston, Massachusetts. From April 2016 to March 2019, adult patients (≥18years old) with suspected acute cholecystitis were enrolled via convenience sampling and underwent a physical exam and a focused biliary POCUS in the ED. Three symptoms and signs (post-prandial symptoms, RUQ tenderness, and Murphy's sign) and two sonographic findings (gallbladder wall thickening and the presence of gallstones) were combined to calculate the Bedside Sonographic Acute Cholecystitis (SAC) Score. The final diagnosis of acute cholecystitis was determined from chart review or patient follow-up up to 30days after the initial assessment. In patients who underwent operative intervention, surgical pathology was used to confirm the diagnosis of acute cholecystitis. Sensitivity, specificity, PPV and NPV of the Bedside SAC Score were calculated for various cut off points. 153 patients were included in the analysis. Using a previously defined cutoff of≥4, the Bedside SAC Score had a sensitivity of 88.9% (95% CI 73.9%-96.9%), and a specificity of 67.5% (95% CI 58.2%-75.9%). A Bedside SAC Score of < 2 had a sensitivity of 100% (95% CI 90.3%-100%) and specificity of 35% (95% CI 26.5%-44.4%). A Bedside SAC Score of≥7 had a sensitivity of 44.4% (95% CI 27.9%-61.9%) and specificity of 95.7% (95% CI 90.3%-98.6%). A bedside prediction score for the diagnosis of acute cholecystitis would have great utility in the ED. The Bedside SAC Score would be most helpful as a rule out for patients with a low Bedside SAC Score < 2 (sensitivity of 100%) or as a rule in for patients with a high Bedside SAC Score≥7 (specificity of 95.7%). Prospective validation with a larger study is required.

Malign Safra Kesesi Polipleri için Risk Faktörleri

PURPOSE: The aim of this study is to determine risk factors for malignancy in gallbladder polyps. METHODS: 92 patients who underwent laparoscopic cholecystectomy due to gallbladder polyp were retrospectively analyzed. Demographic data of the patients, size and number of polyp, the presence of gallstones and histopathological features of the polyps were recorded. RESULTS: 92 patients were included. Mean age was 45.78±11.21 years (21-72). 59 of the patients (64.1%) were female and 33 (35.9%) were male. Mean polyp size was 8.17±2.19 mm and 35 patients (38.0%) had a single polyp, while 57 (62.0%) had multiple polyps (≥2). 47 of the patients (51.1%) had gallstone disease, while 45 (48.9%) had no stone disease. Benign polyps (Group 1) were found in 79 patients (85.9%) and adenocarcinomas (Group 2) were found in 13 (14.1%). Of the benign polyps, 71 (77.1%) were non-neoplastic polyps and 8 (8.8%) were neoplastic polyps (adenomas). Of the 13 patients with adenocarcinomas, 11 (11.9%) were T1a and 2 (2.2%) were T1b. Mean age was 44.32±11.03 years in Group 1 and 54.61±8.07 years in Group 2, the latter being significantly older (p=0.002). Mean polyp size was 7.47±5.51 mm in Group 1 and 12.46±1.89 mm in Group 2, with a significant difference (p&lt;0.001). The cut-off value to detect malignant polyps was a polyp size of 10.5 mm with 92.3% sensitivity, 84.8% specificity, and 0.934 accuracy (p&lt; 0.001). The cut-off value to detect malignant polyps was an age of 50.5 years with 76.9% sensitivity, 67.1% specificity, and 0.767 accuracy (p=0.002). Polyp size and age were important risk factors for malignant gallbladder polyps (p&lt;0.001, OR=2.313; 95% CI: 1.502–3.561), (p=0.004, OR=1.100, 95% CI: 1.030–1.175). CONCLUCISION: We recommend cholecystectomy for asymptomatic patients aged above 50 years with gallbladder polyps larger than 10 mm due to the increased risk of malignancy.

An Analysis of the Differences of Gallstone Presence with Respect to the Variations of Biliary Tracts and Gender

An Analysis of the Differences of Gallstone Presence with Respect to the Variations of Biliary Tracts and Gender

A South Indian Cadaveric Study on the Prevalence of Gallstones

Background Gallstone disease (GSD) is one among the most prevalent diseases that affects approximately 10-15% of the population. It is associated with many other diseases like gallbladder cancer, renal stones, atherosclerosis, coronary heart disease and stroke. Objective Objective of this study is to document the prevalence of gallstones among south Indian cadavers. Method One hundred and twenty three South Indian cadaveric livers/gallbladders were observed for the presence of gallstones. The age range was 40 to 70 years. The gallbladders were palpated to know the presence of stones. They were then dissected and the stones were classified based on appearance. Gall bladder walls were also observed to know the associated fibrosis. Result Among the cadavers studied, 0.81% possessed cholesterol stones and 4.06% had pigment stones. Among the stones, 83.33% were pigment stones and 16.66% were cholesterol stones. Conclusion Compared to the western countries and north Indian studies, the prevalence of gallstone diseaseis low in the south Indian population (4.87%). The low prevalence was probably due to the low socioeconomic status and the diet and lifestyle.

English

BACKGROUND Multiple practice guidelines from different American and European societies recommend index hospitalization cholecystectomy following an episode of gallstone pancreatitis. We wanted to analyse the outcome of patients presenting with acute pancreatitis in the presence of gall stones, analyse the sensitivity and specificity of liver function tests in early prediction of acute biliary pancreatitis and establish the advantages of early intervention in acute biliary pancreatitis. METHODS This is a prospective study conducted at a tertiary care hospital for a period of 12 months among 100 cases of acute pancreatitis who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidaemia. Presence of gallstones was confirmed on ultrasonography. Patients were subjected to preoperative ERCP and endoscopic sphincterotomy. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported. RESULTS Gall stones were the cause of pancreatitis in 16 out of 100 cases (16 %). Male to female ratio was 1 : 3. Mean occurrence of age was 51.1 years. Preoperative ERCP was done 10 cases (63 %). Laparoscopic Cholecystectomy was performed in all the 16 cases (100 %) of which 12 cases (75 %) underwent Lap cholecystectomy in the same admission and 4 cases were subjected to interval cholecystectomy. 1 case was converted to open procedure. Post-operative complications include nausea and vomiting in 2 cases, chest infection in 2 and bile leak in 1. CONCLUSIONS Management of acute pancreatitis in the presence of gallstones requires prompt diagnosis and timely intervention. Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay. KEYWORDS Acute Pancreatitis, Gallstones, LFT, Lipase, Amylase, ERCP, Laparoscopic Cholecystectomy

Clinical Profile and Outcome of Patients with Severe Acute Pancreatitis

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects &amp; Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) &amp; idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy &amp; 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15 0.54, Modified Marshall score of 3.65 1.44, APACHE II score of 9.77 4.45, SOFA score 5.54 2.49, RANSON’s score 3.85 1.80 and HAP score of 0.65 0.63. Conclusion: Most common etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

S0055 Trends of Gallstone-Associated Acute Pancreatitis Within a Large Health Management Organization

INTRODUCTION: Acute pancreatitis (AP) is the third most common gastrointestinal inpatient diagnosis, thereby accounting for significant patient and financial burden. Gallstone AP (GAP) is one of the most common causes of AP in the United States. Guidelines for diagnosis, and management of GAP recommend appropriate criteria for diagnosis, imaging as part of the workup and same-admission cholecystectomy. We characterized trends in diagnosis and adherence to treatment guidelines of patients presenting with GAP in a large healthcare system. METHODS: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health (a nine hospital system) between March 2015 and June 2019. 4,043 patient encounters were eligible for retrospective chart review; these included ED visits and inpatient admissions. Manual review yielded 2,542 charts with complete clinical information. We collected several variables pertaining to the management of GAP including but not limited to demographics, clinical symptoms, laboratory results, imaging, procedures, treatment and outcome variables. Statistical analysis was performed with PRISM (Ver 8.2.1, Graphpad). RESULTS: Out of 2,542 patients diagnosed with AP, 454 were attributed to GAP, of which 401 met Revised Atlanta Classification. The remaining 53 patients did not meet criteria but were labeled as GAP in the presence of gallstones on imaging. 95.8% of patients with GAP presented with pain and 82.4% had elevated lipase and those with prior history of choledocholithiasis were 4.37 times more likely to have GAP (P < 0.0001). About 97.6% of patient labeled with GAP got imaging during the admission but were no more likely to have evidence of gallstones on imaging (OR 1.10, P = 0.3650). Although patients with GAP are 2.48 times (P < 0.0001) more likely to have their etiological workup documented, it is still only documented 62.1% of the time. Despite the diagnosis of GAP, only 34.6% of patients (157/454) got cholecystectomy during the admission. CONCLUSION: The diagnosis of GAP may be erroneously made. In most cases of GAP, it could be the first and only presentation of gallstones. Despite the imaging study being positive for gallstones, appropriate workup for other causes of AP must be done, as a possible etiology can be missed. With the new guidelines focusing on early surgical management for GAP, these numbers could help drive improvements in quality of care in order to prevent recurrence.Table 1Table 2Table 3

Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal

Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging.&#x0D; Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options.&#x0D; Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease.&#x0D; Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion.&#x0D; Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease.

Causes and Treatment of Acute Cholecystitis in Khost Teaching Hospital in age group of 30-80Y during one year of 2019

Background: The presence of gall stones in the biliary system, especially in the gallbladder, can cause serious problems. Objective: The aim of the present study was to study the pattern and frequency of acute inflammation of the gall bladder on patientsaged 30 to 80 years in Khost Teaching Hospital in the year 2019.Material and Methods: In this retrospective research, the patients who were suffering from gall bladder inflammation, and all 51 patients who have been referred to the surgical department of Khost Teaching Hospital for gallbladder inflammation in the last year 2019, and their ages are 30 to 80 years old, were involved after taking prior government approvals. Results and Discussion: According to pathology, in this study from a total of 51 patients, 90% of causes were stones for acute inflammation of gall bladder (GB), hydrops type of GB was 4%, and inflammatory calculus cases were 6%. Compared to other surgical cases, GB-inflammation corresponds to 4%. The occurrence of the disease is in the age of 41 to 50 years and is most common in the female gender.We have done for all cases, open surgery, and in four cases, included cholecystectomy common bile duct (CBD) exploration was also done. Complications were rare and occurred as bile leakage and bleeding. That mortality is less. 48 (94%) causes of inflammation were stones and hydrops type, and 3 (6%) causes were without stones. Conclusion: This research shows that gallbladder inflammation is more common in urban areas, and the inflammation of the gallbladder is more common in the presence of stones than in non-stones.

The Chile Biliary Longitudinal Study: A Gallstone Cohort.

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.

Additional Non-Contrast-Enhanced Computed Tomography (NCECT) of Abdomen to the Routine Magnetic Resonance Cholangiopancreatography (MRCP) Protocol, Increase the Accuracy of Common Bile Duct Stone Detection or Not

Objective: To compare the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in addition to the non-contrast-enhanced computed tomography (NCECT), with MRCP alone, or NCECT alone for common bile duct (CBD) stone detection using endoscopic retrograde cholangiopancreatography (ERCP) as a gold standard. Materials and Methods: The medical records and image findings were retrospectively reviewed in all consecutive patients that underwent both MRCP and NCECT at Phramongkutklao Hospital between May 2012 and December 2015. The imaging data were reviewed using the consensus of two radiologists who were blind of the final diagnoses from ERCP. The accuracy of each modality in detecting CBD stone was reported as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The other associated findings were reported as the presence of gallstones aerobilia, pancreatic calcification, biliary stenting, intrahepatic duct (IHD) dilatation, and CBD dilatation using intermodality agreement and kappa statistics. Results: Two hundred forty-one patients underwent both MRCP and NCECT. The accuracy, sensitivity, specificity, PPV, and NPV of the combined modalities were 98%, 99%, 95%, 98%, and 95%, respectively, which was higher than MRCP alone but it did not reach a statistical significance (accuracy, sensitivity, specificity, PPV, and NPV of MRCP were 97%, 98%, 95%, 99%, and 91%, p=0.77 for accuracy). The other abnormalities found such as aerobilia, presence of gallstone, presence of IHD, and CBD dilatation were similar in both combined MRCP and NCECT as compared with MRCP alone. Conclusion: The accuracy of MRCP alone was good and acceptable for the detection of CBD stone. Adding NCECT to the routine MRCP did not result in a significantly higher accuracy. Thus, routinely adding the NCECT was no longer recommended to avoid unnecessary radiation exposure and increasing the cost of investigation. Keywords: Common bile duct stone, MRCP, NCECT, ERCP, Accuracy

BIOCHEMICAL STUDIES RELATED TO ACUTE CHOLECYSTITIS IN LIBYAN SUBJECTS

Acute cholecystitis and cholelithiasis are one of common health problems of Libyans. [1] Acute cholecystitis or bile gallbladder stones are one of the major surgical problems in the Libyan population and account for many hospital admissions and surgical interventions. This study was done to estimate causes and risk factors of AC among general population of Benghazi city in Libya. Reflux of pancreatic secretions into the biliary duct due to a defect in motility of gallbladder or biliary tree or spastic episodes of Sphincter Oddi may cause injury to gallbladder mucosa and biliary tract which may precipitate acute cholecystitis. Pancreatic biliary reflux (PBR) therefore may cause such reflux of pancreatic juice into gallbladder and biliary tract. This problem is probably related to obesity, cardiovascular disorders (CVD), metabolic syndrome, and dietary habits. Studies on gallstone composition carried out a close link with dietary habits and ethnicity. The biliary composition has been demonstrated by many researches for several years. Gallstone formation is relatively increased with consumption of dietary fats, age and gender.2-3 Estimation of pancreatic amylase in gallbladder bile as well as in serum of patients with acute cholecystitis (AC) may be considered as a biomarker of PB reflux. Serum and bile pancreatic amylase levels as marker for diagnosis of acute cholecystitis" by investigate biliary composition especial alpha amylase pancreatic, total amylase, liver enzymes estimation the correlation between (AST, ALT, ALP and Bilirubin total, C-RP and lipid profile in gallstone disease patients and estimate the correlation between (Cholesterol, HDL, LDL, VLDL) concentration in serum and biliary gallbladder, presence of gallstones, age, in both gender patient with gallbladder diseases.

Risk factors for cholecystitis after stent placement in patients with distal malignant biliary obstruction.

Limited data are available for acute cholecystitis after Self-Expandable Metallic Stent (SEMS) placement in patients with malignant distal biliary obstruction. We aimed to identify risk factors for cholecystitis. This was a retrospective, single-center study of 280 patients (336 stents) who received endoscopic SEMS placement between May 2005 and April 2016. Clinical records were used to perform risk factor analyses. Of 336 SEMS placement procedures, 25 (7.4%) led to development of cholecystitis. Logistic regression analysis revealed three independent risk factors: covered SEMS (P=.014), tumor involvement to the cystic duct (P=.017), and presence of gallstones (P=.022). Median time to cholecystitis onset was shorter with covered SEMS than with uncovered SEMS (P=.034), and in patients with pancreatic cancer compared to those with other cancers (P=.001). Severe cholecystitis developed within 30days after covered SEMS placement in three patients with pancreatic cancer without tumor involvement to the cystic duct. Use of covered SEMS might be a risk factor for cholecystitis onset within 30days after placement. Clinicians should be aware of the risk for severe cholecystitis after covered SEMS placement, even if the tumor does not invade the cystic duct.

P0032INCIDENCE OF GALLSTONES AND ASSOCIATED COMPLICATIONS WITH USE OF THE SOMATOSTATIN ANALOGUE LANREOTIDE FOR POLYCYSTIC KIDNEY AND LIVER DISEASE

Abstract Background and Aims Recently, we performed a large randomized-controlled trial to assess the effects of the somatostatin analogue lanreotide on kidney function and kidney and liver volume in autosomal dominant polycystic kidney disease (ADPKD), the DIPAK-1 trial. Lanreotide had no effect on rate of kidney function decline, but slowed kidney and especially liver growth and is used for this indication in clinical practice1,2. A higher incidence of gallstones has been suggested with lanreotide use, but the exact size and implications of this problem are unknown. Therefore, we systematically studied the incidence of gallstones with lanreotide in ADPKD patients. Method In the DIPAK-1 trial, 305 ADPKD patients (age 18-60 years and eGFR 30-60 ml/1.73m2/min) were randomized to lanreotide or standard of care. MRIs were performed at baseline and end of study (120 weeks). For this post-hoc study, patients with a medical history of cholecystectomy (n=7) or absence of a MRI at the end of study (n=28) were excluded. For the remaining study population (n=270), all MRIs were assessed for presence of gallstones by two trained investigators blinded for study treatment and study period and in case of disagreeing results, an abdominal radiologist was consulted for a final assessment. For patients with gallstones additional follow up after the end of the trial was obtained. Results In 2 baseline and 8 end-of -study MRIs, it was not possible to identify the gallbladder, due to multiple adjacent liver cysts. Of the remaining 260 patients (age 48.5 years, female 49.6%, eGFR 50.0 ml/min/1.73m2), 14 patients (5,4%) had gallstones at baseline, of whom 5 were randomized to lanreotide and 9 to standard care. At the end of study, 32 patients (12,3%) had gallstones, of whom 21 patients had received lanreotide and 11 standard care. During the 120 week lasting study, new gallstones occurred in 17 out of 128 patients receiving lanreotide (13.3%) and 3 out of 132 patients receiving standard care (2.3%), rendering an adjusted Odds Ratio for gallstone formation with lanreotide use of 6.9 (95% Confidence Interval 1.9-24.7) p&amp;lt;0.005). The only other significant risk factor for gallstone formation was female gender (OR 3.5, CI 1.2-10.6, p&amp;lt;0.05). Age, body-mass-index and importantly liver volume were not associated with gallstone formation. Of the 32 patients with gallstones at the end of study, seven experienced gallstone-associated complications. Three experienced a biliary pancreatitis (1 during and 2 after the study). Another one had signs of a chronic pancreatitis as accidental finding on imaging during the study, without having had symptoms. Furthermore, another 3 patients underwent a cholecystectomy for symptomatic gallstones after the study. Importantly, all patients with gallstone-associated complications were part of the subgroup of patients that developed de novo gallstones during lanreotide use in the study. Conclusion Lanreotide increases the risk of gallstone formation in ADPKD sevenfold. Gallstones were associated with severe complications, most occurring after the end of the trial. The benefit of somatostatin analogues to reduce kidney and liver size in ADPKD should therefore be weighed against the higher incidence of these adverse events, and patients and doctors should be aware of the risk of (symptomatic) gallstones with use of these drugs.

A Comparative Analysis of Clinical Characteristics and Histomorphologic and Immunohistochemical Spectrum of Gallbladder Carcinoma in Young Adults (< 45Years) and Elderly Adults (> 60Years).

Gallbladder carcinoma (GBC) is more frequent after 60years of age; its behavior in young adults has not been much studied. A retrospective analysis was performed in patients who underwent a cholecystectomy procedure between the years 2001 to 2016. A group of young patients (< 45) were compared with elderly patients (> 60years) with reference to various clinical, histomorphologic, and immunohistochemical parameters. Statistical analysis was performed using t test and Fisher's test. Survival curves were calculated by Kaplan-Meier actuarial survival curves and log-rank tests. One hundred and one patients with GBC were observed during the study period. Of these, 14 patients (13.9%) belonged to the study group (age range 20 to 45years) and 43 patients (42.6%) constituted the comparison elderly control group (age range 60 to 80years). Forty-four pts. were in the middle-aged group (46 to 59years) and were thus excluded from the study. With reference to age (< 45 and >60), no significant difference was found in sex (females 64.3% vs 69.8%, p = 0.7), presence of gall stones (64% vs 60%, p = 0.8), advanced disease at presentation (T4) (14.3% vs 7%, p = 0.40), incidental detection of gallbladder carcinoma (28.5% vs 28%, p = 0.9), tumor stage at presentation (stage I/II) (35.7% vs 49%, p = 0.39), and poor differentiation (tumor grades G3) (14% vs 12%, p = 0.79). Full-length involvement (28.5% vs 11.6%, p = 0.015) of the gallbladder and abundant tumor necrosis (43% vs 14%, p = 0.021) were more common in the younger patients group whereas adenosquamous and pure squamous cell carcinoma were predominantly observed in elderly patients. Immunohistochemical studies showed higher percentage of overexpression of p53 and Ki-67 proliferation indices in the younger population. Overall survival in younger patients was 48months whereas in elderly patients it was 36months. Histological markers denoting aggressive tumor behavior were observed in gallbladder carcinomas of younger individuals; further studies are needed to delineate the differences in molecular mechanisms involved in progression of the tumor in the two groups.

Predictive factors of gallstone formation after sleeve gastrectomy: a multivariate analysis of risk factors

Obesity and bariatric surgery are both risk factors for cholelithiasis (CL). However, most previous studies have focused on Roux-en-Y gastric bypass, and limited published data are available for sleeve gastrectomy (SG). Patients were evaluated in two groups depending on the presence of gallstones (Group I, present; Group II, absent). Demographic characteristics, comorbid diseases, pre-operative blood values, and early and late weight loss rates were compared between the groups. The study included 111 patients with a mean age of 38.9. The mean follow-up period was 20.6 (12-39) months. During follow-up, gallstone formation was observed in 36.9% (n = 41) of patients. Thirteen patients (31.8%) had symptomatic cholelithiasis that was resolved with laparoscopic cholecystectomy. The mean interval between sleeve gastrectomy and the detection of cholelithiasis was 210days and the mean time of post-operative cholecystectomy was 540days. A multivariate analysis showed that only dyslipidemia was independently and significantly associated with gallstone formation. There was no significant difference in the weight loss rate between the groups. Although CL development was found to be associated with rapid weight loss in several published studies in post-SG patients, the present study showed no significant difference between the groups in terms of early or late weight loss. Pre-operative dyslipidemia may be associated with an increased risk of developing CL.